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NCCN Guidelines for Patients®
Cervical Cancer, 2024
Survivorship » Late and long-term eects
Late and long-term eects
Some side eects of cervical cancer
treatment can start early and linger longer
than expected. Others may not appear until
long after treatment is over. Many cervical
cancer survivors experience changes in bowel,
urinary, and sexual function. More general
eects such as fatigue, trouble breathing, and
diculty sleeping (insomnia) are also common.
The extent and degree of symptoms vary
widely between patients. Ask your treatment
team for a complete list of possible late and
long-term side eects.
Bowel and bladder changes
Urinary incontinence (the inability to hold urine
in the bladder) and urgency (a sudden, strong
need to urinate) are possible after surgery or
radiation therapy for cervical cancer. Watery
and/or frequent bowel movements (diarrhea)
are also possible. Occasional bleeding
may occur either with urination or bowel
movements. Pelvic oor physical therapy,
described next, can help with bowel and
bladder changes.
Ostomy care
If you have an ostomy, you want to join an
ostomy support group. Another option is to
see a health care provider that specializes
in ostomy care, such as an ostomy nurse.
People with ostomies can still live very active
lifestyles. Consider consulting with an ostomy
professional before undertaking vigorous
physical activity.
Pelvic oor physical therapy
The pelvic oor is a group of muscles that
supports the organs of the pelvis. These
muscles play a key role in bowel and bladder
control as well as sexual function and arousal.
There are ways to strengthen these muscles
before and after treatment. This is known as
pelvic oor physical therapy, and there are
health care professionals who specialize in
it. Pelvic oor therapy can include at-home
exercises to tighten and release the vaginal
and anal muscles (Kegel exercises) as well as
hands-on techniques by a physical therapist.
Ask your treatment team for help nding a
pelvic oor specialist in your area.
Infertility and premature
menopause
Surgically removing the ovaries or exposing
them to radiation causes a sudden drop in
estrogen and progesterone. This results
in infertility, and possibly also menopausal
symptoms. These include stopping of periods,
hot ashes, night sweats, weight gain, and
mood changes.
The lining of the vagina can become thin, dry,
and inamed. This is called vaginal atrophy.
Not having enough estrogen can also have
long-term risks, including heart disease and
bone loss (osteoporosis).
When these hormonal changes cause
symptoms of menopause, menopausal
hormone therapy (MHT) may be an option.
This can include systemic (oral or intravenous)
estrogen (combined with progestins for those
with a uterus intact) and vaginal applications
of estrogen. Discussion with a specialized
menopausal symptom team may be helpful to
determine whether this treatment is right for
you.
Vaginal moisturizers
Older age, menopause, and some cervical
cancer treatments can cause the vagina